PB1836: ACUTE MYELOID LEUKEMIA IN OLDER ADULTS IN RESOURCE CONSTRAINT SETTING: SINGLE CENTER DATA FROM SOUTH INDIA
Authors: M. Paul, L. Abraham, C. M. Jeswin, A. Ajithkumar, C. O. D’souza, M. Abraham
Journal: HemaSphere (2022)

Background: Acute myeloid leukaemia (AML) is an aggressive haematological malignancy and is more common in the older adults. The outcome of AML remains highly unsatisfactory in the elderly due to disease-related and patient-related differences between younger and older patients. Data of AML in older patients from the developing nations like India are scarce in the literature. The management of AML in India still remains a challenge due to lack of financial resources and inaccessibility to health care facilities. Most of the elderly patients are denied treatment considering the overall poor outcome and financial toxicity. We analysed the clinico-hematological profile and treatment outcome of patients above 60 years diagnosed with AML during a period of four years in a single centre. Aims: The objective of the study was to analyse the clinical, haematological and molecular genetic profile of AML in older adults and to assess the treatment outcome. Methods: This was a retrospective cross-sectional study including all newly diagnosed AML patients above 60 years of age during the period from January 2017 to December 2020 in a tertiary care teaching hospital. Clinical, haematological, cytogenetic and molecular profile were analysed. The patients were stratified according to the International Prognostic Scoring system (IPSS) cytogenetic categories, molecular risk groups and the European Leukemia Net (ELN) risk categories. They were followed up for a minimum period of one year. Results: Our series included forty four patients with a male preponderance (63.6 %) and age ranging from 60 to 91 years with a mean age of 70. At the time of presentation, 68% patients had a haemoglobin (Hb) level of less than 10g/dL and 43 % had severe thrombocytopenia. Majority of the cases (38) were de novo AML including two cases of acute promyelocytic leukemia (APML) and one case of pure erythroid leukemia. There were six cases of secondary AML including a single case of therapy related AML. Most of the patients(77%) belonged to IPSS intermediate cytogenetic category. Of the thirty eight patients tested, six cases were NPM1 mutated and four were FLT3- ITD mutated. The majority of the patients(41%) belonged to ELN intermediate risk group. Sixteen males and ten females opted for treatment and all of them were given hypomethylating agent (HMA) based chemotherapy. Response assessment marrow was done in four cases, which showed complete remission (CR) in one case and complete remission with incomplete hematologic recovery (CRi) in two cases. Cumulative survival of patients who underwent treatment compared with those who did not (Figure1) showed an obvious survival benefit in the former group(Log Rank{Mantle-Kox}p<0.001). Antifungal prophylaxis was given in twenty patients. Five had reactivation of infection while on antifungal prophylaxis.Nineteen patients had at least one episode of neutropenic fever admissions of which ten patients had more than two episodes. Image:Summary/Conclusion: There is limited data concerning the treatment and survival of elderly patients with AML from developing countries. This cohort gives a glimpse of clinico-hematological profile and treatment outcome of AML in older patients in South India. Our study has shown a definite survival benefit for patients who have taken treatment with HMA when compared to others who opted for palliaton. Larger population based studies with follow up data are required for standardized assessment of patient characteristics and to individualize treatment decisions.